Features of Drainage of the Implant Placement Area in Patients with Incisional Ventral Hernias

Introduction. There are different and sometimes conflicting points of view regarding the drainage of the implant placement area in patients with postoperative ventral hernias. This is due to the variability of drainage methods and the commitment of surgeons to one or another technique. In addition, the results of surgical treatment and features of the postoperative period differ in these patients. Current contradictions in the drainage techniques and management of patients with seromas after hernioplasty for PVH determine the relevance of this issue and the need to obtain additional data on benefits and drawbacks of one method or another.
The aim of the study was to analyse clinical outcomes of patients with postoperative ventral hernias depending on the drainage technique of the implant placement area.
Methods. The study included 392 patients diagnosed with postoperative ventral hernia, who were treated in GBUZ "Samara Regional Clinical Hospital named after V.D. Seredavin" in 2017-2020. Patients’ clinical outcomes were compared and analysed. Group I included 110 patients with passive drain of the surgical wound, group II included 282 patients with active drain. The groups were assessed based on major parameters of the drainage impact on the surgical treatment outcomes. Non-parametric values were compared by calculating the chi-square (χ2), parametric - by calculating the Student's t-score.
Results. In group I, the average duration of hospitalization was 22,56±4,45 bed-days. The average terms of drainage were 2,02±0,69 days. Clinically significant seroma was diagnosed in 35 (32%) patients. The average number of US-guided puncture-drainage interventions was 1,87±0,89 procedures. Suppuration of the surgical wound was diagnosed in 16 (14,5%) patients. The postoperative mortality rate in the group was 3,6%, 4 patients died. In group II, the average duration of hospitalization was 13,57±2,92 bed-days. The average terms of drainage were 6,33±2,12 days. Clinically significant seroma was diagnosed in 42 (14,9%) patients. The average number of US-guided puncture-drainage interventions was 0,65±0,39 procedures. Suppuration of the surgical wound was diagnosed in 21 (7,4%) patients. The postoperative mortality rate was 2,1%, 6 patients died.
Conclusion. Active drain of the implant placement area in patients with postoperative ventral hernias statistically significantly reduces the duration of patients stay in hospital (Student t-score = 11,51 p<0,01), frequency of clinically diagnosed seromas (χ2 = 14,36, p<0,01), frequency of suppuration of postoperative wounds (χ2 = 4,665, p<0,05). When choosing the drainage option for the implant placement area, preference of choice should be given to active penetrating open drain or active penetrating closed drain.